Monday, August 25, 2008

Universal Theory

The family's asleep. (Except for The Teen-she only sleeps during the day). I'm heady with the excitement of web-surfing without feeling guilty or being interrupted for the 88th time. I hardly know where to begin. I lie. Let's begin with my new favorite site: Pioneer Woman. She's my new heroine. Wife, Mom, Cowgirl-what's not to love? Mostly, I envy her ability to pull all areas of her life into one, cool, nifty, link-filled blog. For those in the know (all 3 of you), I have three blogs: this 'ere one, Laughing-Baby, (which is pretty much just my articles for the George St. Coop), and P is for Pooter, my baby blog. Which prompted Robin, from Nova Scotia, to say, "How many blogs do you HAVE, for cryin' out loud?" or something like that.

Anyhoo, I've been thinking for some time about tidying up my baggage, er, I mean bloggage. But I really like the whole donorcycle motif, ya' know? Also, I do get annoyed from time to time with Blogger's inability to say, space properly or upload a picture. So if any of you have mad web skillz, I'd love to talk with you about having my own site, with cool links and funky graphics that aren't stolen from Google images, etc. and that would be easy to maintain and (fingers crossed) maybe turned into a real, money making proposition. Make me an offer, I'm easy. (Shut up, all of you and get your minds out of the gutter.)

Guess what happens when you get a new kidney...


No, seriously. I have plenty of folks complaining about how often they have to go to the bathroom, now what with the new kidney and all. One guy is downright annoying about. I feel like telling him, "Good thing you didn't get a lung transplant, or else you'd be complaining about having to breathe."

In other news, my partner and I have a good system going. He talks to all the difficult patients and I talk to the crazy ones. (In all fairness, I should stress that 90% of our patients fall into neither category). But, also, crazy does love me. I really do seem to have a way with anyone mentally ill, drunk or anyone with more issues than the National Geographic. I could've been a social worker, but I'm not dysfunctional enough. Ba dum bump. Thank you, I'll be here all week. Eat the chicken.

Just so you don't think I'm completely snarky, a patient today told me that I have "sha-fi". Don't ask me how to spell it. Or even if I'm pronouncing it correctly. In his religion, it means I'm a healer. He told me he was blessed to have such people take care of him. The truth is, I'm blessed to do what I do.

Friday, August 15, 2008

One summer apon a time, I used to do agency shifts in this little, rinky-dink, lousy ER near the neighborhood I grew up in. I don't think the equipment had been replaced since my mother worked there in the early 60's. So one night, I went out to the waiting room to discharge this homeless guy who had come in with some minor complaint. We used to get a fair share of homeless patients. I was a little apprehensive. I wasn't sure if maybe he had a psych history or rotten smelling feet or some other issue that would make me want to keep my distance. I shouldn't have worried. With a dignity that I've seldom seen on anyone, rich or poor, we discussed his care. When the discharge instructions were finished, I told him to come back if things got worse and to take care of himself. He looked straight at me and said, "I will and I shall." For a second it was like looking into the eyes of God. Then he shook my hand and left. If Jesus ever returns, you'll find him in an ER waiting room. I will and I shall. It echoes still in my mind.

I have a patient currently who is mentally ill. When she was still in hospital she became very paranoid, telling me that the nurses were keeping her in bed and wouldn't let her go to the bathroom, among other things. (Not true, I checked). Her discharge instructions included several interruptions by her boyfriend to argue with her, when he wasn't looking at me like I was a total waste of his time. I thought, "Hoo, boy, this one's going to have trouble with the follow up." I mean, our clinic schedule isn't rocket science, but it does take getting used to and there is a big onus on the patient to be responsible for frequent medication changes and repeat blood work and keeping track of their daily blood pressure, temperature and fluid intake and output. Trust me, it challenges those firing on all cylinders, as it were. I might even have projected that this one would be screaming at me on the phone every time her creatinine jumped or she had to adjust her prograf.

Instead, I find her to be one of our more pleasant patients. She keeps track, so far, of everything she's supposed to and shows up when she has to. If I think back now to how she was in the hospital, I think of how stressful it must have been to be helpless in a hospital bed, just recovering from major surgery, with lots of noise and little sleep or privacy. Now, she's taking all her meds, she's cut back to 2 cigarettes a day, one in the morning and one at night-which I think is a major accomplishment for her. Have we changed her whole life? I don't think so-she's still dating Mr. Douchebag and she still has whatever issues she had before the transplant. But she's doing well for her. Optimizing the patient's potential, or some such nursing theory stuff like that.

Just for the record, I don't really believe that Jesus is coming back to take the faithful up in a big rapture (although if he does, I am SO upgrading my car). But if you look for it, the Almighty Big-Whatever shows up from time to time in endless, little ways. The question is, how will you react to it?

Tuesday, August 05, 2008

Make your own, home dialysis machine

A baby dying from kidney failure saved when her doctor designed and built her a dialysis machine from scratch in his garage.

That's not a headline you read everyday. Before I opened the link, I was supposing the story came out of Africa, or maybe the Australian Outback. Then I read that it happened in England. ENGLAND. I don't know much about the NHS, but I can't fathom a baby going into kidney failure and the family being told, "So sorry, but she's going to die."

I do know that hemodialysis is hard on the hemodynamics of a 6 pound baby. We had a baby born with kidney failure in the PICU, so he was started on peritoneal dialysis, which is also no picnic on a 6 pounder-their BP can still drop after they drain and although the machine can be reprogramed, it still alarms 80 times a shift because the dwell volumes are so low.

Anyway, back to the BBC. So this doc makes a hemodialysis machine, I suppose out of stuff he had lying around the garage. Goodness knows what I could make from the crap in my basement. A heart-lung machine, probably. How they got the hospital to use it is another wonder-I can't even use a different brand thermometer without a committee vote and a bioengineering seal of approval. And now the baby is a toddler and looking amazingly cute. Dr. McGuyver strikes again.

(Hmmm, when I think about it, the baby probably couldn't have PD because she had already had bowel surgery, so I guess HD was the only option.)

BTW, for all you facebook folks, (you know who you are), I'm on it, but I only visit once in a while, so I'm sorry if I don't return your flowers and zombie hugs and whatnot, but I barely have enough time these days to check my emails and put out the occassional post. So, you can keep sending me quizzes "What are your favorite felonies?" "What smell are you?" but it's unlikely that I'll answer.

Monday, August 04, 2008

Good news everyone!

Remember I mentioned a while back about the Astellas Rose Bowl contest? Well, my friend Steve is one of the winners. Check out his winning essay at Revive Hope. I'm so proud. I can't wait til the parade, so I can point at the TV and shriek, "I know him! I know him!" and generally have my family look at me like I'm nuts, which may be true.

The dust is still settling at work after our recent inspection. I'm just trying to sit at my desk and schmooze with the patients and do my little job and go home like a good girl, for now. In the words of a trusted advisor, "KEEP YOUR MOUTH SHUT!" Hard for me, but I try. I am definitely the Queen of TMI. "Oh, did you not want to know that about me? Sorry, K THNX."

Other than that the summr is winding on. We will have no more vacation days til we straighten out the mess-glad I had that week off. K THNX.

I'm in a little funk today, the past week has brought up some old friends I haven't seen in a while and I ponder getting in touch with them. Well, one, anyway-my BFF from when the teenager was a wee girl. Haven't spoken to her in like 15 years at least. Well, we'll see.

Possibly adding to my pensive state is this video. If you haven't heard of Randy Pausch from under your rock, I highly advice you to take and hour and sixteen minutes and watch it. To that end, I started thinking about my childhood dreams......

  1. To be Quincy. You know, the medical examiner? No, I did not want to be a crusty, old guy like Jack Klugman, but I did want to cut open dead bodies and solve crimes with a trusty sidekick, like Sam. I'm still bitter that nurses don't take Gross Anatomy.
  2. I wanted to be an actress. Did well up until high school. Had the lead in Guys & Dolls, Dracula (the female lead, I was Lucy, not Dracula), and Bye, Bye Birdie and I was in West Side Story, too. But I was not really confident enough in college to pursue it, so most of my singing is saved for the Pooter.
  3. To play the violin. I love the violin. But I play the clarinet. Because that's what we had in my house, my brother's used clarinet. My mother kept telling me that when I got good at it, she'd let me take violin lessons. I made it to first chair and still didn't get violin lessons. But it's not too late. And I am trying to learn piano, so I can accompany my singing. See #2.
  4. To write a book.
  5. To run a marathon.
  6. To travel and live in far flung, exotic places.
Some, like the book, I'm still working on. What are your childhood dreams? Have any come true?